What treatment is recommended for managing diabetes in a patient with adult-onset diabetes and pancreatic insufficiency?

• A. Sulfonylureas
• B. Metformin
• C. Insulin
• D. DPP-4 inhibitors

Answer: (C)

In a patient with adult-onset diabetes and pancreatic insufficiency, the recommended treatment is insulin. This is largely due to the fact that pancreatic insufficiency may lead to an inadequate production of insulin, which can exacerbate glucose control problems. In such cases, exogenous insulin can effectively manage blood glucose levels by providing the body with the necessary hormone that the pancreas cannot produce in sufficient quantities.

Other medications, such as sulfonylureas and DPP-4 inhibitors, rely on the functioning pancreas to stimulate insulin secretion or enhance its action. However, in the presence of pancreatic insufficiency, these mechanisms may be compromised, making them less effective or inappropriate for managing diabetes in this context. Metformin, while commonly used as a first-line treatment in type 2 diabetes, can also be less favorable if pancreatic function is severely compromised due to the potential gastrointestinal side effects and the less predictable blood sugar control in individuals with such conditions.

Thus, insulin therapy is a direct method to replace the missing hormone and is essential for managing diabetes in patients with pancreatic insufficiency.